Similar presentations

2
Objectives  Participants will: Describe the standards for establishing an intervention as “evidence-based” Use guiding questions to determine the level of evidence held by various interventions Describe the features of several interventions with established efficacy for young students and explain how to implement them in their environments

4
“If you’ve seen one child with Asperger’s Syndrome or autism, you have seen one child with Asperger’s Syndrome or autism.” Brenda Smith Myles November 14, 2000

5

6
Evidenced-Based Practice An instructional strategy that:  Has a base of high quality research over a range of different students, in a range of places, and over a range of behavior  Has been shown to result in measurable educational, social, or behavioral benefit

7
Identifying Evidence-Based Interventions  “Reliance on sources such as expert opinion is contrary to evidence-based practice approach because such alternatives have many sources of potential bias.”  Gambrell, 2003 (page 13)

13
Evaluating the Intervention  Measuring progress should occur frequently and systematically  Two questions:  Is the behavior changing?  At what rate is behavior changing?

14
Guidelines for Consumers (Detrich, 2008)  Decisions about interventions should be based on the best available experimental evidence  In the absence of clear evidence-based information, interventions should be developed that use strategies from the established principles of behavior  When modifying an intervention, base it on the established principles of behavior  Select interventions that were tested situations similar to those of the specific student  Direct training should be provided to practitioners  Fidelity measures should be collected regularly  Systematic evaluation of progress should be conducted

17
National Research Council Practices recommended: Curriculum focus on social interaction, play and communication Specialized services—speech/language & occupational therapy Family involvement Consistent and ongoing communication between team members Capacity to address behavioral challenges Specialized and ongoing training and support to staff

18
out/national.php

19
NSP Evidence-Based Interventions 2009 Report is the first. Future reports will expand focus of criteria for inclusion -Looked only at educational and behavioral interventions (excluded biomedical with exception of curative diets) -Looked at only two classes of research design (group and single-subject) -Limited scope to strict diagnostic criteria

20
NSP Strength of evidence Strength of Evidence Classification System used by National Standards Project Established Emerging Unestablished Ineffective/Harmful

27
Evaluative Questions for Interventions Will the intervention impair or detract? cause frustration or regression? What happens if method proves ineffective? Is method balanced with other components? Is the intervention developmentally appropriate?

28
Evaluative Questions for Interventions Has the intervention been validated scientifically? How will the intervention be integrated into the individual’s current program? Have appropriate outcomes and assessment methods been identified? Does it lead to increased independence? What is impact on quality of life?

30
Characteristics of Critical Skills Broad classes of behaviors Variety of contexts Required to complete part or all of activity Not THE activity Not sweeping, taking out trash, washing dishes Instead—communicating need for materials, using both hands together to complete task, initiate social interactions Repeated use throughout all daily activities and routines Activity-based goals may limit opportunities for student to practice skill throughout day (e.g., sweeping) Examples—expressing concerns, bilateral coordination, response to social interactions

31
Identifying What to Teach: Critical Skills Broad classes of behaviors Variety of contexts Required to complete part or all of activity Not THE activity Not sweeping, taking out trash, washing dishes Instead—communicating need for materials, using both hands together to complete task, initiate social interactions Repeated use throughout all daily activities and routines

49
Activity Matrix Time/ Routines Skills Socially interact with peer Ask for items without being told (initiate communicative requests) Paying attention to what adult attends to (joint attention) Play with toys (Imitate motor movements) Make choices between 2 Ask for help Circle time 9:00-9:20 Have greeter role: Hand out materials and greet each peer Point to favorite item— ”look”; give when child follows point Choose order of greting Recess 10:20-10:45 Roll ball back and forth to one peer Withhold favorite toy item (ball); provide opportunity for student to request the ball Car/doll— demonstrate functional act for imitation Choose peer for playing Reading 1:00 – 1:45 Essential item in sight but out of reach Choose book to read for group read

69
What is Prevent-Teach-Reinforce (PTR)?  Research project funded by U.S. Department of Education  University of South Florida & University of Colorado, Denver  Purpose: Investigate effectiveness of PTR process vs. “business as usual”  Comparing treatment and wait-list compariosn groups  Making process prescriptive, yet simple  Intervention “Package”  ONE ‘P’revent; ONE ‘T’each; ONE ‘R’einforce  Based on ABA principles and individual Positive Behavior Support

77
Step 3: Case Study – Mike Hypotheses When….he willAs a result… Mike is asked to complete non- preferred tasks (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher is attending to other students scream and hitMike is able to gain attention and delay the transition/activity Mike is asked to complete non- preferred task (Reading, Math), stop preferred activity or transition to non-preferred activity, fix an error, or when teacher attending to other students express his frustrations appropriately complete the assigned task Mike is able to delay the transition/activity Mike is able to gain attention Inappropriat e Appropriate

79
Prevent Strategies Specific Strategy steps Environmental Support A wait card will be placed on Mike’s desk to assist him in remembering to wait his turn. 1. Prior to group work, tell Mike, “Remember, when it is someone else’s turn, you sit quietly and wait,” while pointing to his card. 2. If Mike calls out, point to his visual to remind him what to do. 3. Use a verbal prompt if the point prompt does not work. Step 4: Case Study – Mike’s BIP

80
Prevent Strategies Specific Strategy steps Environmental Support Mike’s visual schedule will be modified to detail the number of and type of activities he is to complete during non-preferred activities. For example, if math involves listening to a lesson, doing a hands-on activity, and completing a worksheet, his visual schedule will list each activity under math using either a picture of the type of activity or using numbers that correspond to a number on the worksheet. 1. Prior to the start of the activity, Mike should review the visual schedule. 2. As Mike completes an activity, he should X off the activity. Mike’s Intervention Plan

81
Prevent Strategies Specific Strategy steps Curricular Modification Mike will be given an easy, independent activity, such as a worksheet, to complete upon transitioning to a non-preferred activity or an activity that requires him to wait, such as group activities 81

82
Teach Strategies Specific Strategy Steps Replacement Behavior Mike will be taught to use his voice output device to express his need to calm down. Steps: 1. Mike’s device will be programmed to say “I need to calm down.” 2. Prior to transitioning to a non-preferred activity or at the end of a preferred activity, say “If you start to get mad, you can choose to calm down.” 3. As soon as Mike starts to get upset, prompt him to use his device (hierarchy—hand-over-hand, gesture, verbal). 4. Once Mike communicates “I need to calm down”, present him with the choice board of calming strategies and ask him, “What do you want?” 5. As soon as he is calm, praise him (e.g., “You made a good choice.”. 6. Allow Mike to engage in his choice until he is calm for 1- minute. 7. If Mike does not want to leave his choice, then start becoming animated with students in the non-preferred activity.

83
Teach Strategies Specific Strategy Steps Self- Management Mike will be taught to independently use his calming strategies. 1. A tracking sheet with smiley faces and sad faces will be given to Mike at the start of each day. 2. Role-play with Mike about when he needs to make the choice to calm down. 3. Practice completing the tracking sheet. 4. Set and review the daily goal for using the calming strategies. 5. Prompt Mike to complete the tracking sheet if needed

84
Reinforce Strategies Specific Strategy Steps Replacement Behavior Anytime Mike “says” “I need to calm down”, his choice board should be given. 1. Praise Mike for communicating (“thank you for telling me what you need.”) 2. Provide his choice board. 3. Allow him to calm for 1 minute 4. Praise him as soon as he is quiet 5. Praise him for returning to the group Self- Management Anytime Mike scores his behavior, attention should be given. 1. When Mike marks his tracking sheet, praise him for doing so. 2. At the end of the day, review the sheet with Mike. 3. Talk about the sad faces. 4. Provide his reward if his goal is met. WaitingMike will earn a skittle paired with attention if he waits. This will be faded to an intermittent schedule.

85
Reinforce Strategies Specific Strategy Steps TransitionMike will earn stars during Reading Centers if he transitions and completes his work without screaming. 1. A social story will be reviewed prior to Reading Centers to remind Mike that he can earn a star if he comes to centers and works. 2. At the end of each reading center, an adult will review Mike’s behavior with him and ask him if he earned his stars. 3. Provide his stars if earned. 4. During the teacher’s group, Mike can earn 2 stars: 1 for transitioning to the group and 1 for working during group. 5. Allow Mike to participate in his chosen activity if he earned his stars.

86
Step 5: Evaluation Is it working? Daily ratings of behavior Continuous progress monitoring BRS Other data collection forms Is it being implemented consistently and accurately? Fidelity ratings Do we need more data? Does the plan need to be modified or expanded? Plan for generalization and maintenance

87
Step 5: Mike Evaluation

88
Step 5: Evaluation

89

90

91
Manual will be published by Brookes (November 2009) Two journal articles in press (both provided) Journal of Positive Behavior Interventions—Case study Journal of Emotional Behavioral Disorders—Preliminary outcomes Next steps: Facilitating schools to scale up Training key school staff and team members to do process News and Noteworthy